Draft Nursing and Midwifery Order and Draft Health Professions Order 2001

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Draft Health Professions Order 2001

5.41 pm

Mr. Hutton: I beg to move,

    That the Committee has considered the draft Health Professions Order 2001.

During my opening remarks on the NMC, I sought to draw the Committee's attention to areas of similarity between the order relating to the NMC and that dealing with the HPC. The orders are similar to each other because they reflect the same principles and approach that we have adopted towards reform.

We have been anxious to ensure the fullest possible consultation on the order, and, by and large, the councils command substantial support. Unison said that the legislation is fine and that it is a big improvement on earlier versions. The CPHVA says:

    ``This new legislation will guarantee that the public will continue to be served by competent and appropriately educated health visitors''—

I wish that I had used that quote earlier. The Chartered Society of Physiotherapy says:

    ``The CSP warmly welcomes the fact that the CPSM is to be reformed for the first time in over 40 years. The profession has been actively campaigning for reforms which would update and strengthen public protection''.

The shadow HPC has also confirmed its support for the proposals.

In the brief time for which I want to speak about the order, I want to draw the Committee's attention to the issue of chiropodists. The profession is divided between those who are state registered, of whom there are slightly fewer than 9,000 working in both the NHS and independent practice, and those who are not, of whom there are a similar number. The titles of those professions, which are currently regulated by the CPSM, are not effectively protected: anyone can call themselves a chiropodist or physiotherapist regardless of the scope of their practice or training—if any—and whether that training was undertaken in the UK or elsewhere. Struck-off practitioners can lawfully set up in private practice and they can lapse and renew their registration as a right and at will. Successive Administrations have tried to plug that gap by making state registration a condition of NHS employment.

The right answer, as recommended by the review team and accepted by Governments of both parties, is to protect common titles. It is no longer tenable that patients need or deserve less assurance about the competence of practitioners according to whether they use the NHS or the private sector. The greater the access to independent practitioners, the stronger the case for regulation because those in managed services such as the National Health Service are more likely to be subject to a higher degree of quality control.

It is right that the new arrangements provide a pathway to registration for those who want and are able to practise to an effective standard. That will provide fairness and even-handedness. It is not for me to lay down that standard: it must be agreed by the professions as a whole. Accordingly, the order provides for the council either to assess a sustained period of practice as providing a basis for entry to the register, or to match existing qualifications and experience against current entry standards. In either case, the council may apply a test of competence.

That pathway will be open for a limited period from the start of the new register—we propose two years. After that, all entrants will have to meet a common threshold. The criteria used must be open and transparent and decisions must be reasoned and open to appeal. Some unregulated practitioners have asked whether the transitional period could be extended for as long as seven years, but that would not be right. To delay closure of the transitional arrangements much longer would be to continue to deny the public the stronger protection to which they are entitled. The two-year period gives the unregulated sector up to three and a half years from now to meet the standards that the HPC will set in the future. Both sides must co-operate fully to achieve that, and I hope that they will.

I have received representations from practitioners in the unregulated sector saying that the order unfairly discriminates against them, but it does not. It simply requires them to demonstrate that they meet standards of professional training and practice, just as those in the state-registered sector have always had to. If they cannot meet the standards straight away, conditional arrangements will allow them to undergo any necessary further training. There is an opportunity for those in the unregulated sector to work with the shadow HPC to supplement their training so that their students are not disadvantaged if they want to seek registration and patients are not disadvantaged by there being too few fully trained practitioners. I hope that that opportunity will be taken.

Once registered, all practitioners will be subject to the same code of ethics, conduct and discipline. That means accepting an obligation to practise within one's competence. It is firmly in the public interest for the profession to become unified and I hope that all concerned will take the opportunity now presented. The NHS has done its bit: from next year, starting with six pilot sites and gradually extending, all NHS-funded chiropody courses in England will be required to offer credit to those without traditional academic qualifications, or with experience of unregulated practice.

Rather like health visiting, this issue has raised a significant amount of controversy. I assure the Committee that we are not bashing the unregulated sector. We have no intention of so doing, but we think that it is the interest of the public and, ultimately, the professions themselves to resolve the issue. We want to be open and fair. We are not approaching the task in a spirit of hostility or discriminating against those with unregistered qualifications.

Dr. Harris: I do not necessarily disagree with the Minister, but he has now said twice that he is not trying to discriminate against the unregistered sector. He might have seen the same representations that I have, arguing that state-registered chiropodists who never took a degree—even those who trained many years ago and have since retired—should not have to go down the pathway of further qualifications or tests. In a sense, that is discriminatory. Will he comment on that?

Mr. Hutton: There is no absolute requirement that someone with a non-state-registered qualification should take a competency test or acquire further qualifications. That is not what the order specifies. Of course, there is a difference between the two groups of chiropodists, but it is rooted in the fact that some have state-registered qualifications and others do not. That has to be sensibly reflected in the order, and that is what we have tried to do.

I repeat that these are difficult issues, rather like those surrounding health visitors. We have tried to find a compromise and consensus, but they have eluded us. In the interests of the public—that is what the procedure is all about—we have to take measures to end the current, totally unacceptable state of affairs surrounding the regulation of this branch of the profession in a way that is fair. I believe that the proposals are fair and non-discriminatory in intent and that they offer a reasonably sensible way of resolving an issue of long-standing concern, which the Committee must bring to a conclusion.

The order is sensible. It is based on the same set of general principles that relate to the NMC, and I hope that the Committee will support it.

5.49 pm

Mr. Heald: As I said before, we favour regulation. It is a good idea to protect the titles, and we welcome the thrust of what the Government are trying to do. However, we have a difficulty in respect of one profession, which is, as the Minister guessed, podiatry and chiropody. That profession differs from the other 11 in that it is split almost exactly 50–50 between those who are state-registered and are members of the Society of Chiropodists and Podiatrists and those who are not state-registered, many of whom are in the British Chiropody and Podiatry Association, which dates back to 1919 and is the original body that gave qualifications to chiropodists and podiatrists in Britain. It is well known internationally and has its own institute, the SMAE Institute, which trains chiropodists.

When I attended the association's annual convention this year to hear about its members' concerns, they said, ``We are doing something that we have done for a very long time. We have always been the body for the private sector. State registration hasn't been an issue because it wasn't required if you wanted to work in the community.'' They are unhappy about the suggestion that the qualification that is needed in order to work as a chiropodist or podiatrist in the community is a three-year honours degree, the qualification that is insisted upon for those who work in the state sector.

The HPC will be dominated by the state-registered sector. That is no laughing matter. Some 8,000 independent sector chiropodists and podiatrists are out there in the community. Some will be rotten apples—that is true in any profession—but the vast majority are doing important and valuable work. For example, they are the first line of warning for diabetes. The order puts at risk the qualifications of those 8,000 practitioners. That is a worrying prospect. Many of them have practised safely and successfully for many years and their patients need them. Negotiations are continuing and attempts are being made to broker a solution. However, it is said that many may have to re-qualify.

When I attended the association's national convention it was clear that many senior chiropodists feel insulted by the idea that they are being treated totally differently from state-registered chiropodists, many of whom, as the hon. Member for Oxford, West and Abingdon said, got the qualification not by doing the three-year honours course, but because they happened to be qualified through previous experience. Many chiropodists are at the stage of their careers where if they are faced with having to do a three-year honours course with no funding they may as well retire.

The order creates the threat that a large number of chiropodists and podiatrists who are doing useful work may no longer be available to their patients. If such obstacles are put in their way, the public sector will not be able to cope with the work load. The shortage of chiropodists and podiatrists is illustrated by the proposal of the primary care trust in north Lincolnshire to grade patients for access to chiropody services, with the stated aim of treating only people who have a medical and chiropody need. I guess that that is to make supply and demand more in line and to cut costs. That is a case of rationing and does not suggest that we have enough chiropodists and podiatrists to afford to be cavalier. The briefing from the association also talks about shortages.

The order could be damaging to patients. The fact the Minister says that the council will have discretion to decide on training qualifications is little consolation to chiropodists and podiatrists in the community who know that the view of the society, which is represented on the body and which speaks for chiropodists, is different from theirs. Those views have been different for a long time.

The Minister is, in a way, abrogating responsibility by saying that we can leave it to the HPC to decide the issue. Obviously, it is of public importance that we should not lose the services of thousands of chiropodists, and the Government must retain responsibility until they have sorted the matter out. When they have reached a decision in the negotiations and come to a solution about how the various chiropodists are to be qualified in future, I will be happy with the order. However, I cannot countenance the idea of accepting an order that may result in thousands of chiropodists leaving the business, and patients, who desperately need them, not being able to have their services. I hope that the Minister can satisfy me on that point.

That is the position of unregistered chiropodists. However, state-registered chiropodists are also unhappy with the situation, but for different reasons. Their view is that there should be a committee—the proposed body is called the professional advisory committee—made up of a sufficient representation of each profession to advise the HPC on matters of technical and professional detail: not quasi-criminal misbehaviour by practitioners, but professional negligence and practice, and the training and education of chiropodists. The Society of Chiropodists and Podiatrists pus it like this:

    ``Without adequate representation for each profession on the HPC, we fear that there will not be effective protection of the public.''

It goes on to say that it has been in touch with the president of the shadow HPC, Professor Norma Brook, who said:

    ``The Professional Advisory Committees will not be standing committees, but rather would form working panels convened for specific pieces of work, projects or casework.''

The society believes that that is unsatisfactory and that the committees should be standing committees with a duty to advise the HPC. It continues:

    ``We are seeking assurances from Ministers that they regard the involvement of sufficient representatives of each individual profession as crucial to achieving effective protection of the public; and that they therefore support the establishment of Professional Advisory Committees with adequate powers.''

It is also concerned that the PACs should include representatives of each of the four UK countries from each profession. It believes that that is important because:

    ``A biomedical scientist from Scotland could end up representing all the podiatrists, orthoptists and other HPC professions in Scotland. This is both impractical and weighted against professionals in the four countries in a devolved UK.''

The society is seeking an assurance that all 12 allied health professions in the four United Kingdom countries will be effectively represented. I should be grateful to know what the Minister has to say about that.

5.59 pm

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Prepared 26 November 2001